On Pre-implantation Genetic Diagnosis

"A century from now it will no more occur to a normal person to mate with a person eugenically unfit than to marry a habitual criminal" Nikola Tesla, inventor, 1935

A man gifted with extraordinary genius and a flair for scientific discovery, Nikola Tesla, like most fellow eugenists of his time, failed to foresee the advent of a time where assisted reproductive technologies (ARTs) would come to the aid of people who don't fit the "perfect man" eugenic criteria. Pre-Implantation Genetic Diagnosis (PGD) is a fertility procedure which combines IVF and molecular biology techniques to screen the genetic makeup of embryos prior to implantation in the uterus. This enables parents who are (eu)genetically unfit as potential carriers of sex-linked disorders, chromosomal abnormalities and molecular deficiencies to choose healthy embryos for implantation, and discard the defective ones. Since 1990, more than a 1000 babies have been born using PGD treatment, and many families have been "spared" a life-time of emotional suffering and financial distress that having a disabled or malformed child entails. The use of PGD has created numerous new concerns to add to the list of countless ethical and moral issues surrounding ARTs. One major concern is rooted in the religious, philosophical and ethical debate on the moral status of the embryo. Since PGD procedures imply the disposal of those embryos that do not match specific genetic requirements, many religious organizations and doctors have argued that such treatments should be banned as they are immoral, even criminal. This point of view, although irrelevant to the topic discussed in this post, is of great influence on public opinion, and I believe provides a valid substrate for a discussion on the extent of society's intervention in individual and very personal choices such as that of having a child.

Preventive medicine or designer tool?

In 1999, PGD was at the centre of great public controversy when it was used to aid the birth of Adam Nash, the first "designer baby". His embryo was chosen from a selection of 15 to carry human leukocyte antigen (HLA) compatible with those of his elder sister Molly, who, affected by a rare form of bone marrow anaemia, was cured thanks to transplantation of her brother's placental stem cells. Although the Nash family fiercely opposes this view, some have argued that Adam was the first baby to be created as a "medical commodity" and that such cases should be prohibited by law. The general (albeit tacit) consensus from that part of society I like to define as progressive is that these PGD is acceptable/justifiable for those parents who carry defective traits: after all, who would choose moral integrity over the well-being of their children? However, those who object to this tailored use of PGD worry about the lack of regulations concerning the current use and the future direction reproductive technologies will take. If couples have the chance to make sure that their children are not the bearers of genes for non-congenital conditions, such as Alzheimer's or BRCA1 breast cancer gene, how long until parents will be asking doctors to screen their embryos for non-life-threatening traits, such as gender, height, or even a particular talent for maths? Even though science has not reached such an in-depth level of understanding and control over genetic manipulation, it would be foolish to exclude the chance of it happening in the future. The strongest ethical standpoint against the eugenic-type use of PGD hinges on the fear of a future where technology will assist parents in "designing" children according to their personal aesthetic or gender preferences, and even genetically enhance their offspring.

The practice of PGD is currently subject to regional policies and doctor's discretion. The situation could degenerate and PGD could turn into a potential gold mine for Western reproductive business. Furthermore, without clear assertion of what constitutes a "defect", consumer-driven trends of the reproductive market could transform PGD into a designer technology. Many clinics around the world already provide "family balancing" services (fortunately still illegal in the UK), which entail the selection of an embryo according to the parents' desire for a specific gender. A further risk is that, when having the opportunity to decide the genetic characteristic of an unborn, parents will choose certain traits over others merely because they will confer some sort of social advantage on their child. Normal, non-life-threatening traits that may prove disadvantageous because of societal discrimination and inequality, such as homosexuality, would additionally incur the risk of a biological "segregation".

Currently, the lack of worldwide coercive regulations on the matter could have serious social implications. When considering the possible impact of new technologies in the future, we do not have the luxury of being 100% certain of how they will unfold. However, it is unlikely that PGD could become a widespread and common practice, at least in the near future. A single treatment cycle has prohibitive costs (up to £10,000 in the UK) which are generally not covered by insurance companies or national health systems. Therefore the distributional outcome of this technology would necessarily be skewed towards the wealthy classes, leaving those who cannot afford it lagging behind. Could it eventually lead to the creation of a biological divide between social classes, as described in biopunk film Gattaca? The scenario narrated by screenwriter and director Andrew Niccol is that of a world where the GATTACA corporation takes genetic control of the world, and succeeds in creating two genetically diverse sub-populations, one superior to the other. The creation of two different biological human communities is still far from today's reality, but is a matter that does deserve to be discussed in-depth.

The prospect of a world where parenthood will be degraded to a sterile design project is understandably scary and provides a strong ethical standpoint against the eugenic-type use of PGD. Personally, I believe governments and medical institutions should take serious action and strictly regulate patient autonomy of PGD non-medical use. To take precautionary action in this sense means to avoid the development of PGD in what could be compared to the unacceptable eugenic sterilization practices of the 20s. The future social implications of this technology depend on the priorities we, as a society, want to implement. Most importantly, social justice and biological equality are fundamental human rights we owe to future generations. These will depend on the actions that are taken today. This is our responsibility.